Welcome, Ava McDonald our Spring Semester Student Intern!

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Birthstream is welcoming Ava McDonald to intern with us this semester. We have never offered this opportunity to anyone before, but Ava is a unique applicant….we know her family well! She has already witnessed home and hospital births. We hope to offer her the opportunity to observe some prenatal and postpartum care as well as the behind the scenes midwifery work…and maybe a birth or two!

“My name is Ava MacDonald and I am a junior at Da Vinci Charter Academy in Davis and a part of the Da Vinci internship program. My two youngest siblings were born at home with the help of Birthstream Midwives, and now I have the ability to be a part of that. I am very excited to learn more about the Midwifery Model of care and to be able to experience it first hand. I hope that this internship will lead to clarity on my future plans as well as getting to see lots of cute babies!”

Please join us in welcoming her to Birthstream! We know that she will be ready for this adventure!

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Congratulations to Our Midwives!!!


Congratulations Rachel and David Kiene!


Rachel Kiene and her husband David started their marriage with many adventures…a wedding at a top of a mountain plus many hiking and backpacking trips! Now they are embarking on a new adventure…Rachel, David, and her daughter Ruhiyyih are excited to announce that they are expecting a new baby Kiene!

After years of hoping and trying, and a lot of help, Rachel is 15 weeks pregnant. The Kiene baby is expected sometime in July!

Rachel is planning to begin maternity leave in May or June and take at least a year off from practicing midwifery to thoroughly enjoy as many baby snuggles as possible!


Congratulations to Rachel Fox-Tierney!

Rachel at the 2018 National Conference of State Legislatures with Trish Doyle, MP, Austrailia who had home births and wanted to tell us how much she supported midwifery!

Rachel at the 2018 National Conference of State Legislatures with Trish Doyle, MP, Austrailia who had home births and wanted to tell us how much she supported midwifery!

Rachel Fox-Tierney has been elected to the North American Registry of Midwives (NARM) board starting January 1, 2019. NARM is one of the national organizations that serves Certified Professional Midwives (i.e. midwives of our type…we are CPM’s who are licensed by the Medical Board of California).

NARM’s mission includes providing accountability for CPM’s so that they may improve their midwifery practices, developing and administering a standardized examination system (which is used in all 32 states that regulate or license their CPM’s) leading to the credential “Certified Professional Midwife”, and working to promote and increase the role of CPMs in the delivery of midwifery care to families and their newborns across the United States.

This is a huge honor and involves travel to two week-long board meetings per year. The next board meeting will be held in late March 2019 and another in October 2019. (I am very grateful for my midwifery partners full support which allows me to serve midwives and promote midwifery nationally. Thank you dear Birthstream Families for your understanding, I hope not to miss many of your births, but I know I leave you in many compassionate and trusted hands ~RFT)


Please join us in congratulating our midwives and celebrate with them as they begin new adventures!

Midwife Musings: Birthstream 2018 Year in Review

Birthstream families were busy in 2018 growing their families!  As the year came to a close we reflected on all the births we attended and all the new feet we met!  Let's look back on our year...the firsts, the lasts and all the in-betweens.


There were 46 Birthstream Babies (45 births…hmmm):  Girls 23, Boys 23

  • First babies: 12

  • Second babies: 16

  • Third babies: 7

  • Fourth babies: 7

  • Fifth babies: 2

  • Seventh baby: 1

Second generation home birthers:  2  (we took care of their mothers, too!)

Smallest baby was 5 lbs 14 oz and the biggest baby was 10 lbs 10 oz!

  • 5 lbs+ 1 baby

  • 6 lbs+ 9 babies

  • 7 lbs+ 14 babies

  • 8 lbs+ 14 babies

  • 9 lbs+ 6 babies

  • 10 lbs+ 2 babies

  • with 20% of all babies over 4000 grams (8 lbs 14 oz)!

Vaginal birth after cesarean:  2

Cesareans:  2 (one for twins and one for breech)

Baby born vaginally when both parents born by c-sec:  1

Repeat Home birthers: 17 (13 had previous baby with Birthstream!)

Thank you all for sharing your year with us!  We are grateful to be part of those moments as you welcomed new little people into your home.

We look forward to a New Year with Joy and Gratitude...and more babies!

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Come visit us @BirthstreamMidwifery on Instagram and see the many sweet moments from 2018 that can’t be captured by numbers alone!

Welcome Student Midwife, Rachel Schwartz!

Starting August 2018, Birthstream will have a new student!  She has already volunteered at the 2018 Whole Earth Festival midwife booth...even before she was an official student!  We are looking forward to beginning this journey with her.

Rachel at the 2018 Whole Earth Festival.  Flowers by @flowermama

Rachel at the 2018 Whole Earth Festival.  Flowers by @flowermama

Hi I'm Rachel Schwartz and I was born and raised in Davis. I'm about to start my journey as a student midwife with Birthstream.but before realizing the calling of Midwifery I was baking pies at the Collins Farm, helping out on organic farms, and working with kids.

Apprenticing with Birthstream is a dream coming into reality for me. I am so grateful to have this group of wise women initiate me into the art of midwifery.

I have felt drawn to some form of healing arts practice for years: I've practiced as a massage therapist, enjoy yoga and meditation, and love incorporating into my life other tools that enhance my well-being.

I also feel at home in the role of a space holder and support person. In the past two years I've discovered how much I enjoy offering those skills in the space of birth. While living in Missoula, MT in 2015 I took a doula training with Birth Mama Doula. Then in Davis in 2016 I joined the volunteer doula program at Sutter Davis Hospital and began attending and assisting at births. Every time I am present at a birth I feel humbled by its sacredness and awed at the strength and vulnerability of the person in labor.

I now feel called to offer more through the holistic and collaborative form of care that midwifery provides. I love that midwifery creates the space for relationships of real trust to be built between care providers and clients.

It's clear to me that births are shaped by the people who attend them, the environment, and the level of safety and respect the laboring person feels. I love that midwifery care in a home birth setting is uniquely sensitive to these aspects of birth.

I am so excited for this immersion into a midwifery practice that is offering our community something so important! I'm equally excited to meet many amazing families along the way!

Call the Birthstream Midwives! Happy April Fools!

We posted this on Instagram a few days ago, but for those of you not on social media...here it is again!  Who says midwives don't have a sense of humor :)

In an effort to return to our midwifery roots as community midwives, in the future, Birthstream will only serve clients within biking distance. Thank you for your understanding!
(No, not really! April Fools!)

#bikingforbabies#calltheBirthstreamMidwives#midwivesinhats #toomanybagsforbikes


Meet the Midwives at Ebb and Flow Yoga in Vacaville!


Join us for a free information session on home and hospital birth! Knowledge is power.  We will be discussing holistic techniques for a natural birth experience.  Learn about delayed cord clamping, oral vitamin k, what you can do with your placenta after birth and more!  Birthstream offers pre-natal care, home birth and postnatal care.  Whether your little one is born at home, or in the hospital, choose what YOU want for your birth experience.

RACHEL FOX-TIERNEY, LM, CPM is a California Licensed Midwife and Certified Professional Midwife since 2005. Rachel started her apprenticeship with Birthstream midwives in 2000.  Rachel’s two sons were both born at home.  The first in 1997 in Connecticut and the second in 2001 in California with Birthstream.Rachel’s personal and professional experience have offered her opportunities to honor the journey each woman and their family take to bring this little person into their family and into the world. Each of us gives birth in our own way because of what we need and who our babies are. It is our responsibility as midwives to support birthing women physically and emotionally, not to manage her experience. Babies are active participants in the labor dance and often their birth reflects their personality more than the birthing mama’s.

This is a FREE informative session.

Aprons: A Midwife's Love Story

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by Tosi Marceline, LM, CPM

Arriving in our very best party clothes is always surprising to the families when we come to a birth. But if they notice, it may give the birth a special feel, as they realize we came from a wedding, or a party to assist them.  We sometimes have the foresight to put an extra set of clothes in our car, but not always.  Even when we do, we don’t always have time to change! 

We have gone to births at all times of day and from all sorts of places. I remember being out shopping in Sacramento with my young daughter and got a call on my pager (yes, it was more than 20 years ago) and had to find a phone booth to call Amy Morgan, my midwife partner, to let her know the birth was happening fast. She left her children with a friend at the public swimming pool, throwing on her dress over the wet bathing suit and arrived just in time to put on an apron and help catch the baby!

So early in my life as a midwife, I found wearing an apron was practical for many reasons.  For a start, it protects your clothes somewhat. We have all had skirts get soaking wet with "birth fluid", but more often we find our clothes as clean as when we arrived which is helpful when you have a day of appointments after the birth and no time to change.  But more important for you...it is washed, ironed, and cleaner than whatever the midwife is wearing that day!

Our aprons are modest too, and cover us up to our necklines, so that our décolletage is not revealed as we lean over a birth tub to listen to the baby’s heartbeat!

Our deep apron pockets can carry much of what we need to have immediately on hand if the birth is very quick or in a small space. At one birth, the mother escaped her crowd of relatives by hiding in the toilet room (you know what I mean, the room that has only a toilet in it!) Well, with one midwife sitting on the toilet with the laboring woman on her lap, like a birth stool, and me on the floor in front of her with her husband kneeling beside me, there wasn’t a lot of room for much equipment and the pockets in my apron came in handy. This mother was able to push her baby out quickly in a safe and private space...with next birth, she invited fewer people!

Our first aprons were fashioned after Japanese Kappogi Aprons which had elbow length sleeves, as we did not do water births in the 1980’s. Several of our clients traded their sewing skills for part of their birth fee in order to make two aprons for each midwife.

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We need more than two aprons available in case of back to back births, so we supplemented with aprons from the cooking department of our local hardware store, but nothing was quite what we wanted or needed, until I came across an old apron a friend’s grandmother had given me in 1970. I traced a pattern from it onto newspaper, made the neckline higher, the hem lower, and the pockets more capacious.

After we added water birth to our practice, we needed aprons without sleeves, and so I turned to my mother, who offered to sew three aprons for each midwife! Now as I was growing up, my mother made much of our clothing (including matching Christmas and Easter outfits for our dolls.) She is a skilled seamstress, as was her mother and grandparents, who were tailors. It has been a great blessing to be able to wear something handmade by my own mother!


We like wearing aprons for more than just their aesthetic or functional properties. Traditionally, they were made in the home and were often made by women to give as holiday gifts to their friends and relatives. Aprons are most frequently worn in the home or by people providing a service to others and we are a home birth midwifery service! Lastly, they are not scrubs!  We also wear aprons because it conveys a sense of comfort and nourishment.  We know that something good is coming when you see someone wearing an apron...maybe cookies or maybe a baby :)

Aprons have recently made a comeback in the craft and sewing world. I have collected a number of aprons to use in my own home, as time for actual sewing has been limited by births. These aprons, gathered from thrift and second-hand stores, are remarkably diverse, beautiful, and creative. They remind us of each woman’s need to express herself in her work at all levels: in their homes, in their families, in their communities, and in the world. They pay homage to the women’s work we all share.

We always need new aprons, as bleach and wear destroy them eventually.  Last year, my mother passed me the pattern we had developed together and said that it was my turn now. It seems that since I will be going to fewer births as time goes on, I will have more time for another type of creativity as the apron crafter.  Know that each apron will be a gift to midwifery and the families we serve and each stitch will be made with the same tender care we offer to birthing families and new babies.  So next time you see our aprons at a birth, you will know they hold within their fibers the love from generations of women before you and may that give you strength and courage during your transition into motherhood.

Tosi and her mom, Betsy.

Tosi and her mom, Betsy.


See more photos of us in our aprons on Instagram #midwivesinaprons

Midwife Musings: Listening to Birth Stories With an Open Heart

By Rachel Kiene, LM, CPM

The birth of a baby creates a story. Every mother has one for each of her children. In the age of Facebook, many birth stories become public, or at least are shared among a wide circle of friends and acquaintances. Most often, they elicit “likes” and supportive comments from readers. But occasionally, reading a birth narrative in a public forum seems an invitation to offer our perspective, or even criticism of others’ choices.

When I was learning to be a doula, I would hear stories from women who had cesareans or difficult births and immediately think, “What would I have done differently?” The thought was natural. I sought a deeper understanding of the birth process and of how to support women. By identifying avoidable interventions and how they contributed to unwanted outcomes, I hoped to be able to guide my clients more confidently through the challenges of labor and birth. If I could see where things “went wrong”, I might offer thoughts about how things might have been different in a different setting or with a different care provider. But I quickly learned that many women did not welcome the idea that their baby’s birth could have been better.

When we hear or read a birth story, we have a responsibility. How we listen and respond does matter. When we jump to give feedback or to share our own stories, the mother may feel judged or misunderstood. When we listen patiently and choose our responses carefully, we honor the mother’s own healing and learning process.

Each mother’s birth story is a sacred part of her journey into motherhood. The work of bringing her baby into the world affects her identity as a mother. A woman who believes that her baby’s life was saved by surgery or technology has found a way to understand what may have been a negative or even traumatic experience in a positive light. If her friend, trying to be supportive, says, “You didn’t need surgery. You could have birthed your baby if you had been at home with a midwife,” she may hear, “You made the wrong decisions (about place of birth, care provider, when to go to the hospital, etc.) and therefore you caused unnecessary problems for yourself and your baby.” The idea that an epidural or other pain medication may have contributed to birth complications is especially sensitive. The mother may hear, “Your weakness and selfishness caused your baby’s distress/cesarean/vacuum birth/breastfeeding problems/etc.” Since women often share their birth stories in the early days and weeks, these responses may come at a time when she is especially vulnerable and trying to make sense of her experience.

It is very common for women to question the events of their own births. Even a woman who sees her birth as positive may have mixed feelings about some aspects of her experience. As friends, midwives, and doulas, what can we do?

·         DO listen respectfully as she expresses her own thoughts and feelings about her birth.

·         DON’T assume she is dissatisfied with her birth just because it doesn’t meet your ideal.

·         DO answer her questions sensitively and soon return to listening rather than analyzing.

·         DON’T offer your own assessment of “what went wrong”.

·         DO continue to offer friendship and be available when she wants to talk about her birth.

·         DON’T dismiss her feelings of guilt or disappointment, but help her see how she was strong and made the best choices for her baby given the circumstances and the information she had.

·         DO refer her to resources such as the International Cesarean Awareness Network (ICAN), which connect women who have faced similar challenges.

·         DO encourage her to see a trusted care provider or professional counselor if she is experiencing depression or post-traumatic stress disorder (PTSD).  Postpartum Support International has many online resources including "Chat with an Expert" and local resources.

As midwives, we support many women who come to home birth and midwifery care because their previous births were unsatisfying, disappointing, negative, or traumatic. For some of them, the decision to approach birth differently came after months or years of processing. This is an ongoing journey. With a little sensitivity, we can give the mother space to grow into her own wisdom.

Originally Published in Birthstream Newsletter Spring 2015

How Often Do You Need a Pap Test (and did you know midwives can do paps?)

By Rachel Fox-Tierney, LM, CPM

With the beginning of the new year and a newly renewed health insurance plan, my health insurance company sent me a glossy infographic from the CDC letting me know what I can do to "Prevent Cervical Cancer with the Right test at the Right time."  Little do they know that I have in-home Pap tests available to me as a "perk" of being a Birthstream midwife, so I will not need to "talk to my doctor today!"  But the letter was a good reminder to answer the question I often am asked by Birthstream families about when they should get a pap test.

What is a Pap test and why do we do them?  Pap smears, also called Pap Tests, are done to check for early changes in cells in your cervix that could indicate a risk for, or the presence of cervical cancer. HPV (human papilloma virus) screening looks for the specific high risk HPV strains that are associated with increased risk of developing cervical cancer. 

"While in general, the risk of cancer is very low for women in the US, representing only 1.5% of all deaths related to cancer in women, it’s not zero." reminds Aviva Romm, MD.

The American Cancer Society estimates that in 2017 in the US there will be an estimated 12,820 new cases of invasive cervical cancer, and 4,210 cervical cancer-related deaths.  Most cases are present in midlife, in women who have not had regular screening or did not follow up with screening guidelines after an abnormal pap.  If you're not sure what your last pap results were, contact your midwife or doctor and have them send you a copy of the results.

Many of us grew up referring to the pap as our "Annual Exam" because women were recommended to have paps every year.  New guidelines no longer recommend yearly paps.  In part because cervical cancer progresses very slowly, and in 93% of the time requires the presence of one of the high risk HPV strains, so HPV status now plays a bigger role in determining frequency of screening.  But also because, more frequent testing has the possibility of over-treatment which can impact pregnancy and birth.

So how often should YOU have a pap?  According to the American Cancer Society's Guidelines from 2012 (and they haven't changed since then):

  • Women under the age of 21:  NO Paps and NO HPV screening, "HPV is very common in women younger than age 30. Since most HPV that is found in these women will never cause them health problems, it is not useful to test young women for HPV. Most young women will fight off HPV within a few years." according to the CDC.
  • Women 21 -29 years old:  Paps every 3 years, unless abnormal, and NO HPV screening, unless pap is abnormal.
  • Women 30-65 years old:  Paps every 3 years, unless abnormal, or Pap test plus HPV screening every 5 years, IF HPV negative .  Women who are HPV+ will need more frequent pap screening.
  • Women who are over 65 years old:  NO paps or HPV screening, IF they have had normal paps for the previous 10 years and no pap with serious pre-cancerous cells for 20 years.

Individual Considerations:

  • Women who have had a total hysterectomy (uterus and cervix removed):  Stop screening, unless hysterectomy done as a cancer or pre-cancer treatment.  You should consult your MD.
  • Women who have had a hysterectomy without the removal of the cervix:  Screening according to age and risk guidelines above.
  • Women who are high risk for cervical cancer because the have a suppressed immune system or were exposed to DES medication in utero:  May need to be screened more often.
  • Women who have been vaccinated for HPV:  Should be screened according to their age and individual risk guidelines.  The HPV vaccine does not protect against all strains of HPV.
  • Women who are HPV+: Should get pap + HPV screening yearly.

We discuss these guidelines with all of our clients so together we can determine what is the best screening schedule for them given their personal and family history.   We provide pap screening as part of our midwifery care when needed prenatally or postpartum, but we also offer pap screening at any time in a woman's life.

We often get asked,"Can people who aren't Birthstream clients get paps done with you?"  Our answer is, "Of course, because once they use our midwifery service for paps or Well Woman care, then they ARE our clients!  People don't need to have babies with Birthstream in order to enjoy the benefits of in-home Well Woman care!"  

Sometimes medical providers will encourage Pap Screens and describe them as preventative care.  But remember, Pap tests are not really "preventative care", they are "early detection screening tools."  Preventative care is eating a whole food-rich diet, getting walks in the fresh air, having tools for stress management, avoiding smoking and other high risk behaviors, and most of all telling your body what an amazing job it is doing!

There will be some people who do all of the "right things" and still develop cervical cancer because sometimes despite our best efforts we have outcomes that we don't want or expect.  I have cared for people who have developed cervical cancer but have come to the other side, cured in body as well as healed in spirit.  It is possible some times.  So I encourage people to get screened appropriately knowing that I will midwife them through any abnormal results...but likely as is most common, the report will say"within normal limits" or rather as we like to translate "healthy and wonderfully normal cervix!"

If you are interested in having your Pap screen done by a Birthstream midwife, please contact us to schedule an appointment in the comfort and convenience of your own home!